Time to play! [21]

For Halloween, here is a little quiz with scary yet interesting images… What do you see?

Share your thoughts in the comment section and we’ll publish the answer in a week.

See the answer HERE

This entry was posted by Marc-Andre d'Anjou.

5 thoughts on “Time to play! [21]

  1. I find these very challenging when I’m not driving the probe! 🙂

    On the longitudinal images there is a very large cystic structure with echogenic fluid. There are also a large number of polypoid lesions within the structure. There are also hyperechoic structures that shadow present.

    The transverse images show a hyperechoic, enlarged, mildly asymmetric prostate with the left side a little larger. There is a small cyst in the right side. As the probe is moved cranially the large cystic structure becomes visible on the right, then a smaller cystic structure can be seen on the left. The structure on the left has anechoic fluid within it.

    Assessment:
    The polypoid lesions make me think the larger cyst is the urinary bladder with a polypoid cystitis, however on the transverse images this structure seems to originate from the prostate, which is more suggestive of a large paraprostatic cyst. The very caudal aspect of the smaller cystic structure has the appearance of the prostatic urethra, making this the urinary bladder, though I don’t see it the possible urethra as far caudal as I would like.

    My tentative assessment is:
    1) The larger cystic structure is a very large paraprostatic cyst with mineralization present. Though I cannot completely r/o that this is the urinary bladder. The mineralization can be seen in chronic paraprostatic cysts secondary to inflammation, though neoplasia is also possible.
    2) The smaller cystic structure is the urinary bladder or a paraprostatic cyst

    Further diagnostics could include:
    1) Placing a urinary catheter and instilling agitated saline for contrast. This should help clarify.
    2) CT Excretory urogram
    3) Aspiration and fluid analysis and culture from the cyst
    4) FNA of the prostate
    5) Surgical exploration with biopsies and removal of the cyst
    6) If the owners cannot afford or decline surgery medical management can be attempted by draining the cyst (frequently)

  2. Classic for a paraprostatic cyst. The echogenic irregular densities lining the cyst are almost diagnostic for this presentation.

  3. Appears to be a single, large, ovoid hyperechoeic lesion (with hyperechoeic fluid and more polypoid protruberances exending in from the wall and some hyperechogenicies with distal shadowing suggesting mineralised regions); It eminates from the right prostatic lobe and extends cranially (but separate from) the bladder neck on the right side.

    Suspicious of a prostatic or paraprostatic cyst- but seems very unusual- wouldn’t expect the polypoid areas/mineralised regions; or the fluid to be so hyperechoec- so may be an abscess/haemorrhage. Other differentials would be neoplasia/haemorrhage/granuloma.

    Advise minimum database (haem, biochem, urinalysis). Complete AUS- may be best to avoid doing fluid aspiration from the lesion in case its an abscess as could cause peritonitis. Whole body CT (abdomen to check mass and thorax to check for metastases if tumour likely) would be indicated to define the limits of the mass.

  4. I can see an enlarged prostate. Looks like prostatic neoplasia
    Next step will be to do the FNA of the prostate and I will also recommend neutering the patient

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